Objective: Our objective was to describe the presence of Belly Dancer’s dyskinesia (BBD) in a Huntington`s Disease (HD) patient with predominantly behavorial symptoms.

Background: BDD is a rare movement disorder described as rhythmic, involuntary contractions of the abdominal wall, an appearance that resembles belly dancing. This movement disorder has been classically described as preceded by abdominal surgery or intramedullary tumor. However, it has been also associated with neuroleptic treatments and functional aetiology. Anecdotally, BDD is described in Parkinson’s disease or Progressive Supranuclear Palsy patients but not in choreic syndromes as HD.

Method: A 48-year-old man, who had a family history of psychiatric disorders, consulted for delusional ideas, insomnia and abdominal discomfort with mild involuntary movements; being diagnosed of schizotypal disorder. Antipsychotic treatment was proposed but the patient refused it and he only received continued treatment with trazodone. Two years later, the patient was admitted in the psychiatry unit due to a psychotic episode. In addition, relatives reported cognitive decline and gait disturbance. The physical examination revealed ocular pursuit movements preserved with a delay in the latency of horizontal saccades. We noted stereotyped orolingual dyskinesias and choreic movements of the hands, feet, trunk and abdomen. Gait was abnormal due to tandem instability without evidence of parkinsonism, tremor or dystonic postures.

Results: Secondary causes of chorea were ruled out with normal results in blood tests (hemogram, endocrinology, heavy metals, autoimmunity, blood smear and serology exams). Brain MRI revealed caudate nucleus and cortical-subcortical atrophy. Neurophysiology exam reported concordant findings with BDD. Genetic test revealed pathological CAG repetitions (44) in HTT gene. Clozapine was discontinued due to difficulties during the follow-up and treatment with aripiprazole was initiated with behavioral and motor improvement. Despiste the anecdotical exposure to neuroleptic drugs of our patient, pharmacological etiology could not be enterily ruled out.

Conclusion: HD could manifest with BDD, although further studies should clarify its relationship with neuroleptic treatments. The presence of caudate nucleus atrophy, psychiatric family history and/or gait disturbance might make neurologists suspect HD in a patient with BDD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-unusual-case-of-belly-dancers-dyskinesia-in-a-man-with-huntington-disease/